Infective Endocarditis After Arrythmia Device Implantation in Cardiac Surgery Patients.

Overview

abstract

BACKGROUND: Patients undergoing cardiac surgery face an increased risk of infective endocarditis (IE), a risk that may be further exacerbated by implantation of cardiac implantable electronic devices (CIED). This study aimed to assess the risk of IE after CIED implantation within 30 days of cardiac surgery and identify associated risk factors. METHODS: All patients in Sweden, with no previous CIED, who underwent first-time cardiac surgery between 2006 and 2020 were included in this nationwide registry-based study. Cox proportional hazards models adjusted for demographic and clinical covariates were used to estimate the association between CIED implantation and the risk of IE. RESULTS: Out of 73 367 patients, 2302 (3.1%) received a CIED within 30 days. Over a median follow-up of 6.5 years (interquartile range, 3.2-10.1 years), 1556 patients (2.1%) developed IE. CIED implantation was associated with an increased IE risk (adjusted hazard ratio [aHR], 1.46 [95% CI, 1.20-1.77]). Patients with IE had a significantly higher risk of mortality compared with those without IE (aHR, 1.80 [95% CI, 1.67-1.94]; P<0.001). The type of cardiac surgery influenced IE risk, with valvular surgeries showing a higher incidence than coronary artery bypass grafting. Risk factors independently associated with IE included male sex, age at surgery, diabetes, and peripheral vascular disease. CONCLUSIONS: CIED implantation within 30 days after cardiac surgery is associated with an increased long-term risk of IE and subsequent mortality. The type of surgery and patient comorbidities influence the risk.